Post-partum abnormalities

• Immediate examination of the bitch

  Becomes settled after birth of last pup.

  Red/green/brown discharge.

  Frank haemorrhage is abnormal

  Check for presence of milk.

  Passage of placenta may not be immediate.
• Poor mothering behaviour

  Bitch won’t settle; picks up and carries pups, doesn’t let them suck, is aggressive to owner or visitors, is aggressive to pups.

  Often inexperienced bitch/owner.

  Poor whelping environment (too much disturbance)

  Prevent by preparation and familiarisation with the whelping area, restricting visitors, keeping a calm environment.

  Fostering or hand-rearing may be necessary.
• Litter is too large

  Where the litter is larger than the number of teats, supplementary feeding (rotation of pups) or fostering may be required.

  Hand rearing is the least preferred method as it may be associated with poor behaviours development of th pups.
• Post partum disease

  Ordered by most common:

  • Suspected retained foetal membranes
  • Post-partum metritis
  • Inadequate milk
  • Hypocalcaemia
  • Sub-involution of placental sites
  • Haemorrhage
• Suspected retained foetal membranes

  This is commonly suspected

  However the condition is uncommon.

  Placenta usually passed within 20 minutes of each pup.

  Retention suspected if green/black discharge persists after parturition. May be associated with retained pup and placenta.

  Diagnosis requires ultrasound examination: palpation is unreliable.

  In suspected cases oxytocin and antibiotic should be given.
• What is post-partum metritis?

  Bacterial infection following on from:

  • Difficult or prolonged birth.
  • Placental retention
  • Abortion.
• Clinical signs of post-partum metritis

  Depression, pyrexia, anorexia.

  Prurulent vulval discharge.

  Neutrophilia with left shift

  Uterine enlargement.
• Management of post-partum metritis

  Conservative management is feasible:

  • Broad spectrum antibiotics
  • Fluid therapy
  • Ecbolic agents
  • Prostoglandins (synthetic or naturally occurring).
• Inadequate milk - Agalactia

  No milk production.

  • First litter
  • Possible in premature birth.
  • Early caesarean
  • Dopamine antagonists are prolactin agonists = metaclopramide
• Inadequate milk - lack of milk let down.

  Less comm

  Anxiety, pain, stress, cold.

  Treatment is oxytocin administration

  If there is no milk it can not be let down.
• Hypocalcaemia

  Most common in small breeds.

  Commonly in early lactation (rarely in late pregnancy)

  Clinical signs: nervousness, panting, whining, hyper salivation, stiff gait, tetany.

  Frequently there is no marked pyrexia.

  Treatment is calcium borogluconate slowly by IV infusion followed by the same dose SC.
• Sub-involution of placental sites - overview

  Haemorrhagic vulval discharge for longer than the normal 4 to 6 week duration post-partum.

  Often found in young bitches that are otherwise normal.
• Sub-involution of placental sites - diagnosis and signs

  Palpation or ultrasound may reveal na area of the uterus that has not involuted.

  Signs often persist until after the next oestrus.
• Sub-involution of placental sites - treatment

  No significant impact of most treatments:

  • If blood loss is significant then regular observation and Haemotology is warranted.
  • Ovariohysterectomy may be needed.
• Causes of post-partum haemorrhage

  Due to physical injuries of the birth canal

  Or lack of involution of the uterus

  Or following on from a caesarean.
• Treatment of post-partum haemorrhage

  Use of vaginal tampon.

  Ecbolic agents

  If uterine origin and severe may need OVH

  Also if severe in specific breeds may consider a coagulopathy.
• Why is the neonate different to the adult?

  Poor breathing

  Limited ability to regulate body temperature.

  Poor regulation of fluid balance.

  Limited energy store

  Immune system is immature.

  All of these factors result in:

  • Increased susceptibility to disease
  • Poor response to disease (rapid hypothermia, rapid fluid loss, energy depletion and poor immunological response).
  • Potential for a high mortality rate.
• Key aspects of ongoing care for the neonate

  Ensuring colostrum and milk intake.

  Ensuring hydration status.

  Monitoring environmental temperature and pup behaviour.

  Regular clinical examination.
• Neonate care - Ensuring colostrum and milk intake

  Essential to have adequate intake within the first 48 hours.

  Neonates should suck every 2-4 hours.

  Problems: weak pups, insufficient teat (large litters), inexperienced/ difficult dam, continual disturbances by humans.

  Monitor pup weight gain.

  Have alternate food sources available.
• Neonate care - ensuring hydration status

  Simplest method is to evaluate urine colour - normally urine is colourless.

  Other signs (but these may occur later):

  • Dry mucous membranes
  • Slow capillary refill time
  • Skin tenting.
• Neonate care - monitoring temperature

  Ideal environment temperature for neonatal puppies:

  • 28-30C for 1st week.
  • 26C for next 3-4 weeks.
• Neonatal characteristics

  Pups unable to stand at birth but use limbs to crawl.

  Strength gradually increases and standing seen from day 10; most pups walk at 3 weeks.

  Eyes open 10-14 days after brith. Cornea may appear slightly cloudy at first.

  Voluntary defecation/ urination after 2 or 3.
• Treatment of the sick puppy - minor disease

  Any neonate with minor signs of disease (lethargy, slow to feed, lack of weight gain). should have early supplemental feeding.

  If concern over intake of colostrum, a source of frozen-thawed or replacement colostrum should be given before day 3.

  If necessary use tube feeding.
• Significant disease in the sick puppy - signs and treatment

  Absence of feeding, dehydration or other clinical signs necessitate immediate aggressive treatment:

  • Reverse hypothermia
  • Reverse hypoxia
  • Treat/ prevent dehydration
  • Prevent commensal organism overgrowth.

  Despite such treatment the mortality rate can be high
• Treating hypothermia in the puppy

  Slow re-heating (1C per hour).

  Maintain environmental temperatures 29-32 (slightly higher than normal).

  Do not feed if colder than 34C.

  Add dextrose to fluids (as increased calorific demand).
• Predictors of mortality in the puppy

  Low APGAR score (less than 6)

  • HR, RR, response, mobility, Mmemb colour.

  Dehydration (urine is coloured).

  No increase (worse = decreased) in bodyweight.

  Rectal temperature less than 35C.

  Plasma glucose less than 100mg/dL

  Umbilical lactate concentration above 5mmol/L
• What are the causes of fading puppies?

  28% are actually sick at birth

  • Managemental and maternal causes (16%)
  • Very low birthweight (7%)
  • Congenital defects (5%)
  • Often fade and die before day 3.

  55% appear normal at birth may have inadequate surfactant

  • Fade and die between days 3 and 5.

  15% appear normal at birth but succumb to infection

  • Often fade and die after 6.
• Role of lung surfactant

  Poor respiratory function

  Respiratory distress

  Inability to suck

  Fatal cycle of hypoxia, dehydration, low blood sugars, hypothermia and death.

  Abnormal surfactant occurs with:

  • Respiratory distress syndrome
• Treatment of fading pups

  In babies, treatments may include:

  • Corticosteroids prior to pre-term delivery.
  • Endo-tracheal intubation and positive pressure ventilation/
  • Endo-tracheal surfactant administration at birth
  • Corticosteroid administration at birth.
  • Monitoring oxygen saturation.